S.F. General offers relief from big bills

Zander Brandt keeps getting jolted awake.

First, it was at 1 a.m. on Nov. 1 with excruciating pain in his midsection. As I told you recently, he wound up receiving an appendectomy at San Francisco General Hospital and wound up with $92,470 in charges.

A week after the column ran, he was roused from sleep for a much more pleasant reason. A representative from his insurance company, Aetna, phoned from Florida at 6:30 a.m., apparently forgetting about the time difference.

The time was a little annoying, but the news was great. Brandt would instead owe just his $250 co-pay. Was it because of the column?

“Oh, 10,000 percent,” said Brandt, a 31-year-old project manager at a financial technology company. He said Aetna had previously told him any decision on lowering his bill would take six to eight months.

“Insurance companies and hospitals aren’t really going to be proactive about this so they’re forced to be reactive when bad press comes out,” he said.

S.F. General wouldn’t comment on Brandt’s case, but a spokeswoman with Aetna said in a statement: “Although San Francisco General is not currently a participating provider in Aetna’s networks, we reached out to the hospital and negotiated a rate for this claim. Mr. Brandt will not be financially responsible for any amount other than his co-pay. We appreciate the hospital’s cooperation and assistance.”

Brandt and his wife celebrated that night with empanadas and mojitos.

“I was 100 percent thrilled,” he said.

It was one happy ending in the many stories stemming from an unfair billing system at S.F. General that has left thousands of unwitting patients like Brandt with huge bills.

At issue is the hospital’s policy of not entering into contracts with private insurance companies and instead charging the full rack rates approved each year by the mayor and Board of Supervisors. Because there are no contracts, the insurance companies can pretty much pay whatever they want, and the hospital sticks patients like Brandt with the rest. That has repeatedly added up to eyepopping bills of tens of thousands of dollars for more common ailments such as appendicitis, migraines and broken bones.

While the Department of Public Health, which runs the hospital, previously estimated the number of patients affected last year at 300, it now says that number is likely to be as high as 1,700.

Mayor London Breed and the hospital agreed this month to halt what is called balance billing for 90 days while the hospital comes up with a fairer system. That is likely to include entering into contracts with some private insurance companies, setting an out-of-pocket maximum for patients, and expanding who may qualify for charity care.

But the question of whether patients hit with big bills before the 90-day pause are still on the hook remains as clouded as a San Francisco day in July. This month, hospital CEO Susan Ehrlich said, “The retroactive part of it is what we need to study.”

Rachael Kagan, spokeswoman for the city’s Department of Public Health, said Wednesday: “We are pausing all outstanding patient bills . ... When a new patient billing policy is determined, that will be applied.”

A pause is good. A cancellation would be even better.

Supervisor Aaron Peskin has called a hearing for Thursday on the hospital’s billing practices. In preparation, he met Wednesday morning with Ehrlich, public health chief Greg Wagner and other health officials.

According to Peskin, they don’t want to issue a blanket statement zeroing out all previous bills because they still want to wring as much money out of patients’ private insurance companies as possible. But they also know they can’t leave people like Brandt on the hook for the difference if that number is sky high.

“They said, ‘Look, if people call us, they’ll get counseling and we’ll work it out with them,’ ” Peskin said.

Another tidbit he gleaned is that the hospital drops bills if they’re unpaid for four years, though the patients’ credit ratings can be damaged. Peskin said the number of people with outstanding bills received within the past four years is “several thousand.”

Peskin said he told the health officials he wants them to stand up in the hearing and announce they will send letters to every patient with an outstanding bill explaining it will be taken care of by the hospital. We’ll see Thursday whether they take him up on that challenge.

In the meantime, I decided to try to help a couple more patients. One was Tyler Pousson, 33, who lives on Nob Hill and works in tech. He was riding his motorcycle on Lombard Street in February 2018 when a car pulled in front of him, and he swerved and fell.

“My knees were a little sore. I scraped my arm and hand. My helmet got a little banged up,” he recalled. “But there was nothing serious at all.”

A witness called 911, and an ambulance arrived.

“Next thing I knew, they were telling me to lie down, not move, that whole jazz, you know?” he said, adding he had no say in where the ambulance took him, and paramedics insisted on driving across the city to S.F. General, the city’s sole trauma center.

Hospital staff did tests and kept him overnight for observation, but nothing was wrong other than “a few bumps and bruises,” Pousson said.

The bill for determining nothing was wrong? A whopping $58,482.20.

His insurance company, United Healthcare, paid $34,222.68. He showed me a bill from the hospital for $24,259.52 with the words in red type, “PAST DUE.” He couldn’t pay it, and the bill was sent to collections.

“I don’t get how I have insurance, and I’m stuck with a bill for $24,000,” Pousson said this month. “It makes me lose faith in the medical system and the local government, especially. It’s really stressing me out. It’s one of those things that keeps you up at night, and you wonder how you’re going to get out of this.”

The best way to get out of it, it seems, is media coverage. On Tuesday, I asked the hospital about Pousson’s case. A spokesman said he couldn’t comment because of privacy laws. On Wednesday morning, Pousson received a call from the treasurer’s office, which serves as the city’s collections agency, telling him his account is on hold and the hospital is reviewing his case.

“This may be a good sign,” he told me.

Do the right thing, S.F. General!

The hospital did do the right thing for Griffin Knight — eventually. Knight (no relation) had a similar story as Brandt, waking up with severe pain in May, heading to S.F. General and receiving what may be the world’s most expensive appendectomy. Well, the second most expensive, after Brandt’s.

The hospital billed his insurance company, Aetna, $82,000. Aetna paid about $10,000, and Knight owed the rest. He showed me a copy of a bill from S.F. General for $70,248.50 and letters reading, “PAST DUE.”

Knight, a 24-year-old consultant who lives on Russian Hill, said Monday he’d spent 80 hours trying to sort out the mess and had made no progress. He was considering hiring a lawyer or even filing for bankruptcy.

“I’m 24, and this was my first real encounter with the medical system, and it’s been kind of a nightmare,” he said.

I asked S.F. General about his case Tuesday, and again the hospital spokesman cited privacy laws. On Wednesday, Knight received a call from the hospital’s accounting department.

“They said that they will be wiping the entire charge, and I will only owe a $200 co-pay,” he said. “I am ecstatic!”

It was the right decision by the hospital, and one that needs to be repeated many more times.

San Francisco Chronicle columnist Heather Knight appears Sundays and Tuesdays. Email: hknight@sfchronicle.com Twitter: @hknightsf

Santiago Mejia / The Chronicle Zander Brandt owes a $250 co-pay for his appendectomy at S.F. General after his $92,470 bill was forgiven.

Yalonda M. James / The Chronicle Tyler Pousson’s case is being reviewed after he received a $24,259.52 bill from S.F. General for motorcycle injuries that were “nothing serious.”

Santiago Mejia / The Chronicle Griffin Knight owes a $200 co-pay after his $70,248.50 bill for an appendectomy was forgiven.